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Medicare is a federal health insurance program for people 65 years old or older, certain disabled people younger than 65, and people with End-Stage Renal Disease.
Medicare has four parts:
Medicare Part A is hospital insurance that helps pay for inpatient hospital stays, rehabilitative nursing facilities, home health care, and hospice. You likely won’t have to pay a premium for Part A, because you prepaid the premium through payroll taxes while you were working. You are generally automatically enrolled in Medicare hospital insurance (Part A) without a premium, when you apply for Social Security benefits – usually upon reaching 65 years of age, or after receiving disability payments for two years and if you have 10 years of creditable employment.
Medicare Part B is medical insurance that helps pay for doctors' services and outpatient care. You’ll pay a monthly premium for Part B. If you don't sign up for Part B when you become eligible at age 65, or when you have been disabled for two years and you decide you need to join in the future, you may have to pay a penalty for each year you were eligible but didn't enroll. You are responsible for paying the Part B premium that is usually deducted from your Social Security benefits. Medicare pays for many healthcare services and supplies, but not all of your healthcare costs. For example, you pay a deductible for each hospital stay and may pay coinsurance anytime you use the services of a physician or surgeon. Also, drug coverage is limited. Because Medicare rarely pays the full cost of covered services, you may want to consider a Medicare Advantage or Medicare Supplement plan.
Medicare Part C is the Medicare Advantage program. With this option, you can choose to have your Medicare Parts A and B provided by a private insurance company like CarePlus. A Medicare Advantage plan provides Part A and Part B coverage, and, generally, additional benefits.
Medicare Part D is prescription drug coverage. Part D is like Part B – if you don’t enroll in Part D when you become eligible you may have to pay a penalty when you enroll.
Medicare Advantage is a type of health plan that lets you get your Original Medicare benefits from a private insurance company. The Balanced Budget Act of 1997 and the Medicare Modernization Act of 2003 created Medicare Advantage. Some examples of Medicare Advantage plans are:
An HMO features specific lists of in-network doctors, hospitals, and other providers that you must use to receive benefits. Medicare Advantage HMOs often provide additional benefits not found in Original Medicare, including reduced cost-sharing, prescription drug coverage and wellness or fitness programs. If you select a Medicare Advantage HMO, you use it instead of your Original Medicare coverage. However, you can return to Original Medicare down the road if you wish.
Anyone entitled to Medicare Part A or enrolled in Medicare Part B, regardless of income, is eligible to enroll in Medicare Part D, which is a prescription drug benefit plan. This benefit was designed to help Medicare consumers access and pay for prescription drugs. All CarePlus plans include Part D prescription drug coverage in addition to medical coverage.
A PDP is a private, stand-alone plan (PDP) that only offers coverage for prescription medications, (Part D coverage). You can use this plan with Original Medicare or with a Medigap plan. CarePlus does not offer a stand-alone prescription drug plan. Prescription drug coverage is included in all our Medicare Advantage plans, which also include Part A and Part B medical coverage.
You cannot enroll in more than one PDP at the same time, or in a PDP and a Medicare Advantage plan that includes prescription drug coverage (MAPD). Exceptions include Medicare Advantage PFFS plans that do not offer the Part D benefit, a Medicare Savings Account (MSA), or exceptions provided under CMS waiver authority.
If you are considering a PDP, please keep the following in mind:
Preferred cost-share pharmacies provide prescriptions for our Medicare members at a lower cost-share (e.g., copayments) than standard cost-share pharmacies.
Standard cost-share pharmacies provide prescriptions for Medicare members at a higher cost-share (e.g., copayments) than preferred cost-share pharmacies.
Before you select a plan, carefully consider the following questions:
If you recently became eligible for Medicare, through age or disability, you generally have the option to apply for coverage in a Medicare Advantage plan close to the date when your Medicare Part A and Part B coverage starts.
Your Medicare Advantage plan can't start before both your Part A and Part B coverage begins. However, you generally have a period of seven months to apply for coverage in a Medicare Advantage plan.
This means you can apply for coverage in a Medicare Advantage plan three months before, the month of, or three months after your Medicare Part A and Part B coverage starts. You must be enrolled in Medicare Part A and in Medicare Part B. This period is known as the Initial Coverage Election Period (ICEP).
Already enrolled in Medicare?
If you didn't recently become eligible for Medicare, your enrollment options are different and may be limited to certain times during the year.
During this time, Medicare beneficiaries may change and/or enroll in a Medicare Advantage (MA), Medicare Advantage Prescription Drug (MAPD), or Prescription Drug Plan (PDP), or return to Original Medicare. Changes made during this period will take effect on January 1.
If you enrolled in a Medicare Advantage plan, this is when you can switch plans or return to Original Medicare. You can change plans only one time during this enrollment period.
In certain situations outside of the ICEP or AEP, beneficiaries may be able to join, switch, or leave a Medicare Advantage plan or a prescription drug plan during a Special Enrollment Period (SEP).
Some examples of special enrollment situations are:
For more information about Medicare Advantage or prescription drug plans you can call the Centers for Medicare & Medicaid Services (CMS), or go online:
Centers for Medicare & Medicaid Services (CMS)
24 hours a day, 7 days a week
For more information about Medical Assistance through the state, you can contact Florida Medicaid or call your State Health Insurance Assistance Program (SHINE).
Florida Medicaid (Agency for Health Care Administration)
1-888-419-3456; select option 2 for general information about Medicaid
Address: 2727 Mahan Drive, Tallahassee, FL 32308
Monday - Friday, 8 a.m. to 5 p.m.
Serving Health Insurance Needs of Elders (SHINE)
Address: 4040 Esplanade Way, Suite 270
Tallahassee, FL 32399-7000
Monday - Friday, 8 a.m. to 5 p.m.
For more information about Social Security or Railroad Retirement earnings, call or go online:
Social Security Administration (SSA)
1-800-772-1213 (Generally, you’ll have a shorter wait time if you call Wednesday through Friday.) https://www.ssa.gov/agency/contact/phone.html (link opens in new window)
Monday - Friday, 7 a.m. to 7 p.m.
U.S. Railroad Retirement Board
24 hours a day, 7 days a week
Address: 844 North Rush Street
Chicago IL, 60611-1275
To find answers about CarePlus, please logon to the MyCarePlus Member Portal and check out the Journey Guide Booklet for members.
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